No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The association between current unemployment and clinically determined poor oral health
Abstract
The aim of this study was to assess whether current unemployment was associated with poor oral health and whether there was a difference in oral health according to the duration of the current unemployment.
As part of the Health 2000 Survey in Finland (a nationwide comprehensive health examination survey), we used its data based on interviews, questionnaires, and clinical oral examinations of the 30- to 63-year-old respondents (n = 4773). Current employment status was measured in its dichotomous form, employed versus unemployed, and length of current unemployment was classified into four categories. We measured oral health in terms of numbers of missing teeth, of sound teeth, of filled teeth, of decayed teeth, and of teeth with deepened periodontal pockets (≥4 mm, ≥6 mm). Poisson regression models were fitted for all oral health outcomes except number of decayed teeth, for which negative binomial regression model was used. Oral health-related behaviors and sociodemographic and socioeconomic factors were added to the analyses.
The unemployed subjects had higher numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets than the employed ones. The association remained consistent even after adjustments. Oral health-related behaviors seemed to mediate the association. We found no association between unemployment and number of sound teeth. Current long-term unemployment showed stronger association with poor oral health than short-term among women.
The unemployed can be considered as a risk group for poor oral health. Oral healthcare should be reoriented toward those who are unemployed.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
... The unemployed group has unstable nancial conditions ability to pay dental treatment fee. [23]. High GDP per capita is statistically signi cant providing a protective effect in free caries. ...
... [24] Similar to other studies, an increasing number of unemployed individuals can reduce preventive efforts toward the utilization of dental visits. [23,25] Inadequate utilization of healthcare services causes an increased burden of dental caries. [12] Community factors cause low dental utilization in Indonesia such as not being able to pay for treatment, availability access to reach healthcare facilities, economic status, low educational level, and insurance ownership. ...
Background
One of the goals of Indonesia's participation in sustainable development goals to improve its health status. Efforts made to achieve health improvement are increasing the availability of healthcare facilities so people can easily access and get treatment for dental and oral health. This study aimed to determine the relationship between sociodemographic and healthcare services factors that affect tooth decay and filling in Indonesia.
Methods
A cross-sectional study using secondary data from Basic Health Research 2018 as classified based on WHO age as much 14.031 subjects are sociodemographic factors, utilization of dental visits, total decay, and filling. Health Facility Research 2019 data using 17.741 healthcare facilities. The number of dentists as much as 22.926 data through the Indonesia Medical Council on December 2021. These variables were tested statistically and mapped using QGIS.
Results
Mann-Whitney test showed a significant difference (p < 0,05) between the female sex, living in the urban area towards tooth decay and filling. Kruskal-Wallis test showed a significant difference (p < 0,05) between groups of informal, formal workers with unemployment, educational level in 35–44 years group between no school and elementary-high school with diploma 3-college and group of 65 + years between all groups, and also frequency utilization towards tooth decay and tooth filling had significant statistics. Spearman test showed a correlation statistically (p < 0,05) between the number and ratio of healthcare facilities and dentists towards tooth decay and filling.
Conclusion
In this study, there is a relationship between sociodemographic factors and healthcare services that affect tooth decay and filling. Efforts to equitable distribution of healthcare facilities and dentists, as well as an intervention to increase utilization by looking at all aspects of sociodemographic characteristics.
... The studies are mostly on Asian adults using the cross-sectional design. 14,15 Therefore, the aim of this study was to explore the relationships among oral conditions and OHRQoL on labour market entry, using the path analysis to assess direct and indirect effects, as well as mediations with individual variables and family SES. Our hypothesis was that oral conditions and OHRQoL on early adolescence would influence employment outcomes in young people. ...
... Oral health-related quality of life was answered by adolescents through the Brazilian short version Child Perception Questionnaire 11-14 (CPQ [11][12][13][14]. 19 This questionnaire contains 16 questions about oral symptoms, functional limitations, emotional, and social well-being domains, and their impact on daily life. ...
Aim:
To evaluate the influence of the oral conditions and oral health-related quality of life (OHRQoL) on the entry of adolescents on labor.
Design:
This cohort study was performed in southern Brazil, within a random sample of 12 year-old adolescents (n=1,134). Oral health (dental caries, malocclusion, and toothache), OHRQoL (Child Perceptions Questionnaire 11-14), demographic factors and family's socioeconomic status (household income and mother's education) were collected at baseline (2012). Education level and employment outcomes, such as labor market entry and earnings from work, were collect at six years follow-up. Path analysis was used to estimate the overall fit measurement, standardized coefficients (SC), and its direct and indirect effects.
Results:
Among 1,134 participants, 768 adolescents with mean of age 17.5 years old were reassessed (retention rate of 68%). There was direct effect from poor OHRQoL on labor market entry (SC 0.057; p=0.02). Sex and age also had a direct effect on employment outcomes. Socioeconomic status impacts oral health conditions as well as OHRQoL scores (p<0.01). Household income, malocclusion and toothache had indirect effects on labor market entry.
Conclusion:
Oral health indirectly affects employment outcomes, through its effects on OHRQoL. Moreover, OHRQoL directly affects labor market entry in adolescents.
... Regarding oral health, experiencing unemployment or job loss during pregnancy can reduce the ability to afford dental services due to financial hardship and loss of dental insurance, weaken the individual's networks, and thus reduce attention to self-care. While unemployment is a known risk factor for health [18] and poor oral health (i.e., dental caries, periodontal disease), [19,20] limited research has investigated the connection between employment status, job loss, and oral health experiences during pregnancy. Extant research on the link between occupational status and oral health is scarce, and most of it is from outside the U.S. The small available literature suggests that most pregnant women receive insufficient dental care, [21][22][23] with the main barriers being financial stress (e.g., costs), [22,24,25] work-related aspects (e.g., time constraints, discrimination), [24][25][26] but also a lack of information about pregnant women's oral health. ...
Background
Oral health is an essential component of a healthy pregnancy. While most women work full-time while pregnant, research has overlooked the impact of occupational status and job loss on oral health experiences during pregnancy. To examine the impact of employment status and job loss on oral health experiences during pregnancy in the United States.
Data
Data are from eight sites (Georgia, Massachusetts, Minnesota, Missouri, North Carolina, New York State, New York City, and Wisconsin) of the Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2016–2020 (n = 31,362). Multiple logistic regression is used to assess the relationship between occupational status (including employment status and unwanted job loss) during pregnancy and oral health.
Findings
Women who experienced an unwanted job loss in the prenatal period were at elevated risk of not having dental insurance, not receiving a dental cleaning during pregnancy, having an oral health problem, and having unmet dental care needs.
Conclusion
Experiencing unwanted job loss around the time of pregnancy is an important life event that corresponds to worse oral health experiences. There is a need for greater focus on adverse life events, such as job loss, especially during pregnancy, as a mechanism for oral health issues and challenges with proper access to dental health systems.
... Several factors can harm adults' oral health, such as stress at work, healthcare policies, and health-insurance companies [34]. Uncertainties about how unemployment affects oral health are yet unanswered, but there are some hypotheses that could explain the reality such as the fact that dental care is considered expensive even for employed adults and that public dental care is almost nonexistent in some countries [34,39]. The Portuguese government has implemented a few policies and programs to improve oral health in the country, including initiatives to increase access to dental care for disadvantaged groups and to promote oral hygiene and preventive care. ...
Oral health surveys are essential for assessing the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analyze dental caries experience for which dental treatment was sought in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, and sociodemographic, behavior, and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9349 participants (5592 females/3757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR = 1.01, 95% CI [1.00–1.02], occupation (OR = 2.94, 95% CI [2.37–3.65], OR = 3.35, 95% CI [2.40–4.67], OR = 2.55, 95% CI [1.66–3.91], for employed, unemployed, and retired, respectively), overweight (OR = 1.52, 95% CI [1.18–1.96]), reporting to have never visited a dentist (OR = 0.38, 95% CI [0.23–0.64], and self-reported week teeth status (OR = 2.14, 95% CI [1.40–3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal.
... Several factors can harm adults oral health, such as stress at work, health-care policies, and health-insurance companies [35]. Uncertainties about how unemployment affects oral health are yet unanswered, but there are some hypotheses that could explain and explain the reality such as the fact that dental care is considered expensive even for employed adults and that public dental care is almost nonexistent in some countries [35,39]. The Portuguese government has implemented a few policies and programs to improve oral health in the country, including initiatives to increase access to dental care for disadvantaged groups and to promote oral hygiene and preventive care. ...
Oral health surveys are essential to assess the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analysis dental caries experience who sought dental treatment in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, sociodemographic, behaviors and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9,349 participants (5,592 females/3,757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR= 1.01, 95% CI [1.00-1.02], occupation (OR= 2.94, 95% CI [2.37-3.65], OR= 3.35, 95% CI [2.40-4.67], OR= 2.55, 95% CI [1.66-3.91], for employed, unemployed and retired, respectively), overweight (OR= 1.52, 95% CI [1.18-1.96]), reporting to never visited a dentist (OR= 0.38, 95% CI [0.23-0.64] and self-reported week teeth status (OR= 2.14, 95% CI [1.40-3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal.
... A few studies have examined the relationship between employment status and oral health, including some that examined the association between unemployment and oral health [14][15][16]. To our knowledge, only one crosssectional study has reported significant associations between the workplace-related factors such as precarious employment status and poor self-rated oral health [17]. ...
Background
Temporary employment leads to psychological distress and higher mortality, but data on its associations with oral health is limited. We examined whether having the experience of temporary employment was associated with tooth loss among working adults in Japan. Methods
We conducted a cross-sectional study from the 2010–2011 Japanese Study on Stratification, Health, Income, and Neighborhood study that analyzed 2652 participants aged 25–50 years (men = 1394; women = 1258). Independent variable was changes in employment status (continuous regular employment and the experience of temporary employment). Dependent variable was self-reported tooth loss (none, 1 tooth, 2 teeth, 3 teeth, 4 teeth, and more than 4 teeth). Covariates were sex, age, years of education, self-rated household economic status in early life at 5 years old, marital status, number of family members in the household, history of diabetes, and body mass index. We conducted a negative binomial regression analysis to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (95%CIs) for tooth loss. We also confirmed the interaction term between changes in employment status and sex. ResultsThe median age of the participants was 37 years. The percentages of men and women who experienced temporary employment were 14.5% and 61.3%, respectively. Compared with continuous regular employment, the experience of temporary employment was significantly associated with tooth loss in both sexes after adjusting for the covariates (men: PRR = 1.50 [95%CI = 1.13, 2.00]; women: PRR = 1.42 [95%CI = 1.14, 1.76]). The interaction term between employment status and sex was not significant (p = 0.71). Conclusions
Temporary employment is adversely associated with oral health.
A significant research gap on socioeconomic determinants of oral health among older persons is that socioeconomic indicators, like employment status, have essentially been problematized and measured using a cross-sectional approach. Based on a life course approach, and using data from a population-representative, face-to-face and longitudinal-retrospective survey focused on older people in Chile (N = 802), we reconstructed representative types of individual employment trajectories and measured their association with different oral health indicators in old age. Our results show that employment trajectories characterized by continuous, formal, full-time employment have a protective effect for multiple oral health indicators among older people. Our study demonstrates the need for public policies on oral health in old age to incorporate a life course approach and to consider the negative impact of constantly working in informal employment or being out of the labor market permanently, particularly in countries like Chile where temporary and informal employment has risen steadily.
Objectives
To systematically evaluate the literature on whether plaque‐disclosing (PD) methods, applied by dental professionals (FQ1) or at‐home (FQ2), combined with verbal oral hygiene instructions and brushing demonstration (standard OHI) lead to improvements in self‐performed dental plaque control in comparison to standard OHI alone.
Materials and Methods
Seven databases were searched by two independent reviewers according to pre‐specified eligibility criteria up to September 2020. No restrictions regarding language, date and type of report were imposed. The Cochrane Collaboration’s Risk of Bias tool (RoB 2.0) were used for quality appraisal. Multiple comparisons referring to a single study were included if the articles evaluated different PD agents. Narrative synthesis using evidence tables were performed.
Results
Seven eligible studies were retrieved, including data of 430 individuals (159 wearers of orthodontic appliances). The studies exhibited considerable heterogeneity regarding outcome assessments and follow‐up. 11 (eight corresponding to FQ1 and three to FQ2) out of 13 relevant comparisons found no significant difference between techniques for dental plaque outcomes and three (two corresponding to FQ1 and one to FQ2) out of five comparisons indicated a positive effect of standard OHI with aid of PD methods on gingival inflammation scores. With respect specifically to orthodontic patients, three out of four comparisons indicated significant improvements on gingival inflammation scores for individuals instructed with PD methods.
Conclusion
Clinicians should consider PD agents as adjunct to standard OHI in orthodontic patients. For those without appliances, PD methods can be used as an alternative.
Natural teeth are still lost in adults despite improvements in dental care and access to treatment across the life span. The study examined whether tooth loss can be mitigated in adults experiencing diabetes. National online survey data from the Service Utilization among African Americans with Co-morbid Depression and Diabetes (n = 275) were analyzed using logistic regression analyses. Diabetes was most prevalent among men (73.5%) and least prevalent among women (40.6%). In general and among the women, those without diabetes have approximately 50% fewer missing teeth than those with diabetes (odds ratio = .50; 95% confidence interval: 0.30, 0.83). Tooth loss is a traumatic experience and a serious life event that requires professional attention.
The objective was to investigate the role of employment in the 11-y changes of clinically determined oral health. We used data from the longitudinal Health 2011 Survey, including reinvited subjects from the Health 2000 Survey. Data were gathered by clinical oral examinations, interviews, and questionnaires of those aged 30 to 63 y (n = 1,031) in 2000. Exposures were change in employment from baseline to follow-up and length of unemployment. Outcomes measures were the numbers of missing teeth, sound teeth, filled teeth, decayed teeth, and teeth with periodontal pockets (≥4 mm and ≥6 mm). Separate mixed-effects and conventional negative binomial regression models were fitted for each oral health outcome. Demographic, socioeconomic, and oral health–related behaviors were added as covariates to the analyses. The findings showed that unemployment was inconsistently associated with poorer clinically determined oral health over 11 y. These effects were attributed to income and education and, to a lesser extent, to oral health–related behaviors. The length of unemployment was also inconsistently associated with oral health. The study concluded that one socioeconomic factor, unemployment, had a partial impact on oral health.
Background
It is acknowledged that a variety of patient factors are known to influence consultation length as well as outcomes and complication rates following surgery. As little research has been published in this area, our aim was to compare the prevalence of such factors amongst foot and ankle surgical patients treated in the private and public sectors.
Methods
Information was prospectively collected on 100 consecutive new patients presenting to foot and ankle clinics in private practice, a trauma center and a metropolitan hospital. Data was collected for age, primary pathology, availability of home support, employment status, necessity for interpreter, smoking status, presence of diabetes and ASA (American Society of Anesthesiologists) status.
Results
Statistically significant differences were found between the private and public patients for availability of home support, employment status and necessity for an interpreter. When compared with the other two sets of patients, the trauma center had a greater proportion of smokers and diabetics. In addition, a higher ASA grade was observed.
Conclusion
A statistically significant difference in patient factors was noted between patients treated in the public and private sector and between a trauma center and a metropolitan hospital. We believe that careful consideration of these issues is needed when interpreting clinical outcomes and assessing potential service provision.
Study design
Cohort study.
Although the unemployment rate in Germany is currently low, more than a million persons in the country have been out of work for more than a year. In this review article, we address these persons' state of health, the effect of unemployment on health, and the influence of macroeconomic factors and social policy.
This article is based on a selective review of pertinent literature in the PubMed database.
Large-scale meta-analyses and systematic reviews have shown that the long-term unemployed have an at least twofold risk of mental illness, particularly depression and anxiety disorders, compared to employed persons. Their mortality is 1.6-fold higher. Unemployment seems to be not only an effect of illness, but also a cause of it (i.e., there is evidence for both selection and causality). Learned helplessness is an important psychological explanatory model. Limited evidence indicates that the long-term unemployed have a moderately elevated prevalence of alcoholism; unemployment can be both an effect and a cause of alcoholism. Unemployment also seems to be associated with higher risks of heart attack and stroke. Cancer can lead to loss of employment. The link between unemployment and poorer health is strengthened by macroeconomic crises and weakened by governmental social interventions.
The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment. The vicious circle of unemployment and disease can be broken only by the combined effects of generally available health care, special health-promoting measures among the unemployed, and social interventions.
Purpose
Long-term unemployment has negative effects on both mental and physical health. In combination with an inactive lifestyle, it often leads to functional or constitutional limitations that make reemployment in the labor market difficult especially for older adults. The presented pilot study examined a 3-month-long interventional program for improving health of older, long-term unemployed persons with regard to its effectiveness and acceptance by the target group.
Methods
The low-threshold intervention was offered by a job training center that supports reemployment and was divided into lectures for enhancing the individual health competence and a supervised physical training part in a fitness center. One hundred and nineteen long-term unemployed workers (53.7 ± 3 years) took part in a prospective investigation with 3 data collection points: before intervention (T1), after intervention (T2, n = 94), and 6 month after intervention (T3, n = 59). The spectrum of methods included the assessment of nutritional status, cardiovascular risk factors, physical fitness, chronic backache, and depression.
Results
As a result of the intervention, the physical fitness improved significantly (maximal oxygen uptake: p < 0.002). Cardiovascular risk factors like systolic and diastolic blood pressure (p < 0.016; p < 0.001) and percentage body fat (p < 0.017) decreased significantly. There were also remarkable effects in the reduction in depression (p < 0.028). Chronic backache was lowered in more than 50% of the cases.
Conclusion
The health promotion program reached people who have a desire to improve both physical and mental health. To assume responsibility for their own health may be a first step in regaining self-confidence and lowering the work placement barriers.
This paper presents results from the 1998 Adult Dental Health Survey using multivariate analysis. This enables analysis of several variables at one time to see which are having an effect on people's oral health. The paper compares these variables to a variety of outcome measures and makes recommendations for dental practice.
This paper examines the impact of job loss on a number of non-fatal health events, which are nonetheless severe enough to require hospital in-patient care. We focus on job loss due only to establishment closures, as this reduces the problem of distinguishing between causation and selection. Using linked employee-employer register data, we identify the job losses due to all establishment closures in Sweden in 1987 or 1988. During a subsequent 12-year period, we find that job loss significantly increases the risk of hospitalization due to alcohol-related conditions, among both men and women, and due to traffic accidents and self-harm, among men only. We find no evidence, however, that job loss increased the risk of severe cardiovascular diseases such as myocardial infarction or stroke.
The increased unemployment rates during the 1990s were followed by decreased cigarette consumption. The aim of this study was to analyse the association between unemployment and smoking habits among young men and women during times of prosperity and recession. Two groups of final-year pupils were surveyed five years after leaving school, at the age of 21, in 1986 (boom) and 1994 (recession). The boom group included 1083 pupils; the recession group 898 pupils. The non-response rate was 2% in the boom group and 10% in the recession group. Daily tobacco use was measured through self-administered questionnaires. Daily cigarette smoking was of a lower magnitude during the recession (9.7% among men and 21.9% among women) compared to the boom (19.8% and 37.8%, respectively). A low level of education, and among women also financial problems and motherhood, were associated with more frequent smoking. Unemployment was associated with tobacco consumption, especially among women and during the boom. Thus, smoking habits were found to be a question of both unemployment and tobacco trends in society.
Several studies conducted in Western countries have shown significant associations between stress factors and periodontal disease. However, there have been only a few studies conducted in Asian countries. The present study was designed to identify possible relationship between stress and periodontal disease in residents of a rural area in Japan. -
Data were collected from 1,089 adults with at least six natural teeth in a typical farming district of Japan. Subjects were asked to complete a questionnaire on daily stresses in various aspects of life. Data on gender, occupation, smoking, alcohol drinking habits, dental health behavior and systemic disease status were obtained from the questionnaires. Periodontal disease status was assessed using clinical attachment loss (CAL), and the subjects were dichotomized according to mean CAL<1.5 mm (control group) and>/=1.5 mm (diseased group). Logistic regression was applied to assess the associations between stress and other factors with periodontal disease, and odds ratios (ORs) as well as 95% confidence intervals were calculated.
In bivariate analysis, significant relationships were found between periodontal disease and stress within 1 month (P<0.001), job stress (P<0.001), self-health-related stress (P<0.001) and family health-related stress (P<0.01). Logistic regression analysis revealed that subjects who felt job stress (OR=1.71, P<0.05) and those who felt stress due to self health (OR=1.72, P<0.05) were more prone to have periodontal disease than were those who never or only rarely felt such stress. Significant correlations were also found between periodontal disease and smoking habit, frequency of dental clinic visits and hyperlipidemia (OR=1.8, P<0.05, OR=2.0, P<0.001, OR=2.1, P<0.05, respectively). -
The results suggest that stress related to self health and job might be potential risk indicators for development of periodontal diseases. Intervention measures including stress reduction may provide adjunctive approaches for preventing and treating periodontal disease.
Chronic, untreated oral disease adversely affects one's systemic health, quality of life, and economic productivity. This study evaluated the effect of rehabilitative dental treatment on the oral-health-related quality of life and employment of welfare recipients. Three hundred and seventy-seven participants in a novel welfare dental program received oral examinations, questionnaires, and rehabilitative dental treatment. Seventy-nine percent of participants exhibited improvement in their oral-health-related quality-of-life scores following dental treatment. Improved OHIP-14 change scores were associated with being Caucasian or African-American, initial poor general health, severity of treatment urgency, worse baseline oral-health-related quality-of-life scores, subsequent patient satisfaction with the Dental Program, and resolution of their chief complaint (all p < 0.04). Those who completed their dental treatment were twice as likely to achieve a favorable/neutral employment outcome (OR = 2.01, 95%CI = 1.12, 3.62). Thus, oral health improved the quality of life and employment outcome for this welfare population.
Clinical observations and epidemiologic studies suggest that some negative life events and psychological factors may contribute to an increased susceptibility to periodontal disease. The aim of the present study was to systematically review the evidence from case-control studies, cross-sectional studies, and prospective clinical trials reporting on the influence of stress and psychological factors on periodontal disease. The focused question addressed in this systematic review was whether the scientific evidence is enough to consider stress and psychological factors as risk factors for periodontal disease.
A literature search was conducted using two databases (MEDLINE and the Cochrane Oral Health Group specialist trials register) in addition to searching reference lists of original and review articles. The search strategy used was the combination of the terms: "stress," "periodontal disease," and "psychosocial disorders." Studies were selected if they were published in dental journals between January 1, 1990 and April 1, 2006; only human studies and studies with adults and middle-aged subjects were included. Suitable variables included control for the potential effect of confounding factors, adequate criteria to define periodontal disease, adequate criteria for establishing stress, and methodologic quality. Only English-language articles were considered, and unpublished data were not sought. Two reviewers independently extracted information regarding quality and study characteristics in duplicate. The studies were assessed regarding their methodologic characteristics, statistical analysis, characteristics of the periodontal outcome measures, and psychological measurements.
Of the 58 articles identified in the search, 10 were excluded because they were reviews and 34 did not comply with the selection criteria. Fourteen articles (seven case-control studies, six cross-sectional studies, and one prospective clinical trial) were included in the analysis; their quality and main study characteristics were assessed according to the criteria preestablished in the protocol of the study. With regard to the results of the studies, 57.1% found a positive outcome between psychosocial factors/stress and periodontal disease, 28.5% observed a positive outcome for some characteristics and a negative outcome for others, and 14.2% found a negative outcome.
Within the limitations of this systematic review, the majority of studies showed a positive relationship between stress/psychological factors and periodontal disease. However, in the future, well-designed and more representative studies should be considered to confirm these factors as a risk for periodontal disease.
There are social gradients in general health and oral health. However, there have been few studies addressing whether similarities exist in the gradients in oral and general health in the same individuals. We set out to test, using data from NHANES III, whether there are social gradients in oral health, and whether they resemble the gradients in general health. Income, indicated by poverty-income ratio, and education gradients were examined in periodontal diseases, ischemic heart disease, and perceived oral/general health. Our analysis demonstrated consistent income and education gradients in all outcomes assessed. In the adjusted regression models, the probabilities of having poorer clinical and perceived health were attenuated, but remained significantly higher at each lower level of income and education for most outcomes. The results showed similar income and education gradients in oral and general health, implying commonalities of the social determinants of both oral and general health.
The increased unemployment rates during the 1990s were followed by decreased cigarette consumption. The aim of this study was to analyse the association between unemployment and smoking habits among young men and women during times of prosperity and recession. Two groups of final-year pupils were surveyed five years after leaving school, at the age of 21, in 1986 (boom) and 1994 (recession). The boom group included 1083 pupils; the recession group 898 pupils. The non-response rate was 2% in the boom group and 10% in the recession group. Daily tobacco use was measured through self-administered questionnaires. Daily cigarette smoking was of a lower magnitude during the recession (9.7% among men and 21.9% among women) compared to the boom (19.8% and 37.8%, respectively). A low level of education, and among women also financial problems and motherhood, were associated with more frequent smoking. Unemployment was associated with tobacco consumption, especially among women and during the boom. Thus, smoking habits were found to be a question of both unemployment and tobacco trends in society. Public Health (2000) 114, 460–463.
OBJECTIVES: To analyse the associations between unemployment and suboptimal self-rated health as well as high alcohol consumption, and to examine the role of possible mediating factors explaining the associations from a gender perspective. STUDY DESIGN: The sample, from a 14-year longitudinal study with a 96.4% response rate, consisted of 386 women and 478 men who were either employed or unemployed at 30 years of age. METHODS: The health outcomes studied were suboptimal self-rated health and high alcohol consumption at 30 years of age. Logistic regression was used for analysis, and the relational theory of gender was used to discuss the findings. RESULTS: A strong relationship was found between unemployment and suboptimal self-rated health among women, and unemployment and high alcohol consumption among men, even after controlling for health-related selection, potential mediators and background factors. All mediating factors in the model were attributable to suboptimal self-rated health among unemployed women. Two mediating factors were also substantially related to high alcohol consumption among unemployed men. CONCLUSIONS: Long-term unemployment at a young age could have various health effects in men and women. At present, the mechanisms behind the health consequences are better understood among women. Research would benefit from developing theories in order to explain how youth unemployment leads to gendered health consequences.
OBJECTIVES: Earlier research on health-related selection into unemployment has been based on relatively severe health problems, leaves questions unanswered about particular problems, follow-up times have been short and the measurement of unemployment utilised has been crude. The present study explores the effects of suboptimal health on employment in the long term, with statistics that enable assessment of the occurrence and extent of unemployment. STUDY DESIGN: Employment status of a population cohort (n = 1083) was measured half-yearly from 18 to 42 years of age with four follow-up surveys. METHODS: Health status at 30 years of age was assessed with nine indicators. Their associations with the occurrence of a period of unemployment during the subsequent 12 years were analysed with Cox proportional hazard models, and generalized linear models were applied in assessing their associations with prolonged unemployment. RESULTS: Suboptimal self-rated health and suboptimal mood were the most robust predictors of both occurrence of unemployment {hazard rates 1.48 [95% confidence interval (CI) 1.13-1.94] and 1.59 (95% CI 1.19-2.12), respectively} and prolonged unemployment [risk ratios 1.95 (95% CI 1.66-2.29) and 1.44 (95% CI 1.24-1.67), respectively]. Significant associations, particularly with prolonged unemployment, were also seen for musculoskeletal pain, suboptimal sense functions and sleep quality, and smoking and risky alcohol intake. CONCLUSIONS: There is health-related selection into unemployment in early middle age, irrespective of unemployment earlier in the life course. High risk ratios for prolonged unemployment suggest that selection takes place, in particular, at re-employment. The findings indicate the need for policies to prevent those with a history of health problems being at a disadvantage in terms of future employment.
Abstract This case-control study (n=100 dental patients, matched for age and sex) investigated the rôle of life-events in periodontitis. Data collected included life events, tobacco use, oral health behaviours and socio-demographics. The results of conditional simple logistic regression analysis showed that periodontitis was associated with the negative impact of life-events (p<0.01), the number of negative life-events (p<0.05), high levels of dental plaque (p<0.01), tobacco smoking (p<0.01) and being unemployed (p<0.05). These associations remained statistically significant after adjusting for oral health behaviour and socio-demo-graphic variables, but not tobacco smoking (p>0.05). Marital status became statistically significant after adjusting for the other variables (p<0.05). A model is suggested to explain the pathways through which life events may affect periodontal health. It was concluded that psychosocial factors and oral health risk behaviours cluster together as important determinants of periodontitis.
Background, aims: The hypothesis that psychosocial stress and lifestyle are related to periodontal status was tested. Material and methods: The study was performed in 1997-98 in 10 areas in Lithuania (response rate 53%). Information comprised recordings of oral hygiene, calculated levels of remaining periodontal support and information about psychosocial and lifestyle factors. A hypothetical structure was tested in 2 age and gender subgroups by means of a structural equation model both for an overall fit and for the fit of individual parameters within the model. Results: The hypothesised structure presented high confirmatory fit index values (CFI) in all subgroup models, i.e., CFI >0.94. However the probability value of 0.01 found in the older males model presented an unlikely event. When individual parameters within the models were tested, different misspecifications were found. Therefore the hypothesised structure needed to be revised and tested repeatedly. All revised models presented high CFI and probability values (p>0.35). The testing of individual parameters did not reveal any significantly misspecified parameters. Conclusions: The path between lifestyle and levels of remaining periodontal support was empirically supported in the present study. Although the pathway between psychosocial stress and remaining periodontal support was not empirically supported, there is reason to believe that such link is likely.
Objectives: An important factor in social interaction is physical appearance. Major elements in the evaluation of physical appearance are the mouth and teeth. The purpose of this study was to evaluate the effect of tooth appearance on the development of a first impression of the other person, with regard to the sex of both the respondent and the target. Methods: Eight facial photographs of individuals with intact upper teeth were manipulated: one set was left untouched and the other was professionally altered so that the front anterior teeth appeared decayed. The photographs were randomly aligned in sets of eight, each set consisting of four individuals with an original, intact dentition and four other individuals with a “decayed” dentition. The sets of photographs were then presented to 115 respondents (65 males and 50 females). Evaluations were made according to three categories of traits—esthetic, social, and professional. Results: For all three evaluation categories, the difference in scores between decayed and intact dentition given to targets were significantly higher when participants of one sex evaluated targets of the opposite sex, as compared to evaluating targets of their own sex. Conclusions: The effect of tooth appearance on the physical attractiveness stereotype is more evident when males evaluate females and vice versa, rather than when evaluating their own sex.
Tseveenjav B, Suominen AL, Vehkalahti MM. Oral health-related behaviours among dentate adults in Finland: findings from the Finnish Health 2000 Survey. Eur J Oral Sci 2012; 120: 54–60. © 2012 Eur J Oral Sci
The aim of this study was to assess oral health-related behaviours among dentate adults. As part of the comprehensive Finnish Health 2000 Survey, this study included dentate subjects, 30–64 yr of age (n = 4,417). Based on interview and questionnaire data, information on nine oral health-related habits was elicited. On average, study subjects reported 4.4 (SD = 1.5) oral health-promoting behaviours among the nine behaviours investigated, the mean number differing according to subjects’ gender, educational level, marital status, and employment status. Older age, higher level of education, cohabiting, and being employed were indications of higher numbers of oral health-promoting habits than were younger age, lower levels of education, being single, or being unemployed. Oral health-promotion activities should be tailored and targeted in terms of adults’ socio-economic and demographic characteristics, and directed especially towards men, those with lower education, and those who are single or unemployed.
In Canada, national health surveys do not usually include questions pertaining to self-perceived oral health. Those that do use ad hoc sets of questions rather than standardized and validated measures of the functional and psychosocial impacts of oral disorders.
To collect national data on the impacts of oral disorders from a representative sample of Canadian adults and to compare the results with similar national surveys conducted in the United Kingdom and Australia.
Data were collected from adults by means of a telephone interview survey based on random-digit dialing. Oral health was measured with the short-form Oral Health Impact Profile (also known as the OHIP-14 questionnaire), which asks about the frequency of 14 functional and psychosocial impacts that people have experienced in the previous year as a result of problems with their teeth, mouth or dentures.
Of 3,033 interviews conducted, data were sufficient for analysis for 3,019 respondents. Just under one-fifth of the 3,019 respondents (19.5%) reported 1 or more of the 14 impacts "fairly often" or "very often" in the previous year. The prevalence was higher among edentulous respondents (30.7%) than among dentate respondents(18.6%), as were the extent and severity scores. The prevalence of impacts was lowest in Atlantic Canada (16.1%) and highest in the Prairies (23.3%), although the difference was not statistically significant. Prevalence rates and extent and severity scores were highest among those who wore dentures, recipients of public dental care and irregular dental visitors. Considerable income disparities were also observed, with 34.9% of those from the lowest-income households reporting impacts. The prevalence of effects and the extent and severity scores in Canada were similar to those reported from the United Kingdom and Australia.
One in 5 Canadian adults experienced adverse impacts from oral disorders. Further work is needed to identify the material and psychological determinants of these impacts.
Although life expectancy in the European Union (EU) is increasing, whether most of these extra years are spent in good health is unclear. This information would be crucial to both contain health-care costs and increase labour-force participation for older people. We investigated inequalities in life expectancies and healthy life years (HLYs) at 50 years of age for the 25 countries in the EU in 2005 and the potential for increasing the proportion of older people in the labour force.
We calculated life expectancies and HLYs at 50 years of age by sex and country by the Sullivan method, which was applied to Eurostat life tables and age-specific prevalence of activity limitation from the 2005 statistics of living and income conditions survey. We investigated differences between countries through meta-regression techniques, with structural and sustainable indicators for every country.
In 2005, an average 50-year-old man in the 25 EU countries could expect to live until 67.3 years free of activity limitation, and a woman to 68.1 years. HLYs at 50 years for both men and women varied more between countries than did life expectancy (HLY range for men: from 9.1 years in Estonia to 23.6 years in Denmark; for women: from 10.4 years in Estonia to 24.1 years in Denmark). Gross domestic product and expenditure on elderly care were both positively associated with HLYs at 50 years in men and women (p<0.039 for both indicators and sexes); however, in men alone, long-term unemployment was negatively associated (p=0.023) and life-long learning positively associated (p=0.021) with HLYs at 50 years of age.
Substantial inequalities in HLYs at 50 years exist within EU countries. Our findings suggest that, without major improvements in population health, the target of increasing participation of older people into the labour force will be difficult to meet in all 25 EU countries.
EU Public Health Programme.
To report on the oral health status and its impact on the life quality of homeless people in Hong Kong.
A cross sectional epidemiological survey involving clinical oral examinations and face-to-face interviews with 147 homeless participants. Clinical examinations were carried out following WHO criteria. The impact of oral health on quality of life was assessed with the short form of Oral Health Impact Profile, OHIP-14.
Over 90% had caries experience and most related to untreated decay. The mean DMFT score for dentate subjects was 8.1 (DT = 3.4, MT = 4.0, FT = 0.7). Periodontal disease was highly prevalent, 96% having periodontal pockets. The burden of oral health on their daily lives was common, 88% reporting an oral health impact within the past year. A multiple regression analysis indicated that the OHIP-14 score had significant associations with self-rated oral health, dental pain, employment status and length of time being homeless (p < 0.05). Those who assessed rated oral health as 'poor/very poor', reported dental pain in the past year, were unemployed, and homeless for more than one year had poorer oral health related quality of life (significantly higher OHIP scores) than their counterparts.
Among the homeless population studied, oral health status was poor and its impact on their life quality was substantial. The oral health impact was associated with socio-demographics and perceived dental problems.
The purpose of this analysis was to assess selected social consequences of maintaining oral health and treating oral diseases. The associations among socioeconomic and demographic factors with time lost from work or school and reductions in normal activities are explored.
Data were gathered as part of the 1989 National Health Interview Survey from 50,000 US households (117,000 individuals), representing 240 million persons. The oral health care supplement was analyzed using the software SUDAAN to produce standard errors for estimates based on complex multistage sample designs.
Because of dental visits or problems, 148,000 hours of work were lost per 100,000 workers, 117,000 hours of school were lost per 100,000 school-age children, and 17,000 activity days beyond work and school time were restricted per 100,000 individuals in 1989. Exploratory analyses suggest that sociodemographic groups have different patterns of such time loss and of reduced normal activities.
Overall, there is low social impact individually from dental visits and oral conditions. At the societal level, however, such problems and treatments among disadvantaged groups appear to have a greater impact.
The perception and significance of dental appearance was investigated in three groups of patients. One group had a missing front tooth replaced by partial dentures, which were taken out during the tests. A second group had some missing (pre-)molars. A third group had a complete natural dentition and they acted as control group. Color photographs of the teeth were made and a clinical examination was carried out. The psychological impact of dental appearance was measured by way of a scale of words with affective connotations. Social impact was assessed by way of changes in daily activities. Dentists and lay-persons were asked to give an opinion of the dental appearance on the basis of the pictures. It was found that a missing front tooth resulted in less positive feelings and more negative feelings and also that this condition affected daily life activities strongly. Missing (pre-)molars caused less of an aesthetic problem. Dentists and lay-persons were quite alike in their appreciation of dental appearance, whereas the respondents themselves had different opinions. An explanation for these differences and their implications for dentists are discussed.
It is well established that many systemic adverse health conditions have manifestations in the oral cavity. The purpose of this paper is to summarize the available scientific evidence that describes the opposite effect, how adverse oral health conditions affect three aspects of daily living: 1) systemic health, 2) quality of life, and 3) economic productivity. Examples of oral health affecting systemic health include rheumatic fever patients who develop infective endocarditis from oral bacteria and organ transplant patients who develop severe complications from oral infections. Both systemic health and quality of life are compromised when edentulousness, xerostomia, soft tissue lesions, or poorly fitting dentures affect eating and food choices. Conditions such as oral clefts, missing teeth, severe malocclusion, or severe caries are associated with feelings of embarrassment, withdrawal, and anxiety. Oral and facial pain from dentures, temporomandibular joint disorders, and oral infections affect social interaction and daily behaviors. The results of oral disorders can be felt not only physically and socially but also economically in our society. Dental disease accounts for many lost work and school days. Lower wage earners and minorities are disproportionately affected. Although there are many studies that evaluate these relationships, most are case reports, cross-sectional studies, or studies restricted to small or unique population groups. Lack of standardized measurements make comparisons across studies difficult. More population-based and longitudinal studies are needed to better understand the nature of these relationships.
The aim was to compare how general lifestyle, gender and occupational status determine dental health behavior. All the 1012 55-year-old citizens of Oulu (a medium-sized Finnish town) were invited to participate in this study. 780 of them did so. Information about frequency of toothbrushing, use of extra cleaning methods, use of sugar in coffee or tea, and time of the last dental visit, lifestyle, occupational status and gender was gathered from the 533 dentate subjects. Lifestyle was measured by means of questions about physical activity, tobacco smoking, alcohol consumption and dietary habits. Females and people with a healthy lifestyle brushed their teeth more often. Extra cleaning methods were used more often by people with a healthy lifestyle, whereas gender and occupational status had a weaker association. Males and people with a lower occupational status used sugar in coffee or tea more often. The time from the last dental visit was longer among workers and men; lifestyle had no significant association. At the population level oral cleaning habits are a matter of a health-oriented lifestyle and gender-related behavior. The dental visiting habit has a weaker association with general lifestyle.
The hypothesis that psychosocial stress and lifestyle are related to periodontal status was tested.
The study was performed in 1997-98 in 10 areas in Lithuania (response rate 53%). Information comprised recordings of oral hygiene, calculated levels of remaining periodontal support and information about psychosocial and lifestyle factors. A hypothetical structure was tested in 2 age and gender subgroups by means of a structural equation model both for an overall fit and for the fit of individual parameters within the model.
The hypothesised structure presented high confirmatory fit index values (CFI) in all subgroup models, i.e., CFI >0.94. However the probability value of 0.01 found in the older males model presented an unlikely event. When individual parameters within the models were tested, different misspecifications were found. Therefore the hypothesised structure needed to be revised and tested repeatedly. All revised models presented high CFI and probability values (p>0.35). The testing of individual parameters did not reveal any significantly misspecified parameters.
The path between lifestyle and levels of remaining periodontal support was empirically supported in the present study. Although the pathway between psychosocial stress and remaining periodontal support was not empirically supported, there is reason to believe that such link is likely.
The goal of this study was to examine whether psychosocial conditions for general health described in the public health literature are also reflected in tooth loss.
The relation of psychosocial factors to missing teeth was evaluated among 2,501 individuals aged 25 to 59 years from the population-based cross-sectional Study of Health in Pomerania using logistic regression analyses. The case group included 15 percent of participants of each 5-year age group with the highest number of missing teeth.
Unemployment, dose-dependent current and former smoking, a poor general health status, and a longer time since the last dental appointment were significant risk indicators for missing teeth. Alcohol consumption, use of interdental cleaning products, and checkup as the reason for the last dental visit were protective. Women with low education and low income were identified as a high-risk group for missing teeth by the three-way interaction between gender, school education, and household income. The effect of marital status was modified by gender: being single was a risk indicator for men but it was protective for women.
The study supports the hypothesis that psychosocial conditions that affect health status as described in the general public health literature also have an effect on tooth loss. Strategies to prevent tooth loss may be expeditiously implemented in combination with approaches to prevent other health-related problems.
Previous research has shown that involuntary job loss may have negative health consequences, but existing analyses have not adequately adjusted for health selection or other confounding factors that could reveal the association to be spurious. Using two large, population-based longitudinal samples of U.S. workers from the Americans' Changing Lives Study and the Wisconsin Longitudinal Study, this analysis goes further by using respondents' self-reports of the reasons for job loss and information about the timing of job losses and acute negative health shocks to distinguish health-related job losses from other involuntary job losses. Results suggest that even after adjustment for numerous social background characteristics and baseline health, involuntary job loss is associated with significantly poorer overall self-rated health and more depressive symptoms. More nuanced analyses reveal that among involuntary job losers, those who lose their jobs for health-related reasons have, not surprisingly, the most precipitous declines in health. Job losses for other reasons have substantive and statistically significant effects on depressive symptoms, while effects on self-rated poor health are relatively small.
Significant gains have been documented on the oral health of Australian children. However, the question remains as to whether improvements have extended to the oral health of young adults. This study aimed to determine the risk indicators associated with oral health status in young adults aged 20-25 years.
A random sample of young adults was selected from the South Australian electoral roll. Telephone interviews were conducted for 1261 young adults. These provided socio-demographic, health behaviour and dental visiting data. Dental examinations were carried out on 644 subjects by three calibrated examiners in clinical settings.
The mean number of tooth surfaces affected by dental caries (DMFS) was 6.05 with the presence of untreated cavitated decayed surfaces (DS) evident in 28.6 per cent. In regression models the risk indicators associated with DS were being on government benefits, unemployed, usually visiting for a problem rather than a check, visiting a public clinic, drinking 5+ acidic drinks per day and being a current smoker. Risk indicators for higher DMFS scores were usually visiting for a problem, visiting a public clinic, being on government benefits and having made a dental visit in the previous 2 years.
Socio-demographic factors, dental visiting patterns and general health behaviours are risk indicators for caries in young adults.